Contents
- Introduction
- Indications
- Position of patient
- Landmarks and incision
- Internervous plane
- Superficial dissection
- Deep dissection
- Dangers
- How to enlarge the approach
- Figures
Introduction
- Allows inspection of the anteromedial ankle joint and the anteromedial part of the dome of the talus
Indications
- Used mainly for ORIF of the medial malleolus
Position of patient
- The patient is placed supine on the operating table
Landmarks and incision
Landmark
- Identify the anterior and the posterior borders of the medial malleolus
Incision
- A 10-cm longitudinal curved incision, with its midpoint just anterior to the tip of the medial malleolus
- Begin proximally 5 cm above the malleolus and over the middle of the subcutaneous surface of the tibia, crossing the anterior third of the medial malleolus
- The incision is curved forward to end 5 cm anterior and distal to the malleolus
Internervous plane
- No internervous plane.
Superficial dissection
- Widen the skin flaps
- Identify the long saphenous vein and the accompanying saphenous nerve, which lie just anterior to the medial malleolus
Deep dissection
- Incise the remaining coverings of the medial malleolus longitudinally to expose the fracture site
- Make a small incision in the anterior capsule of the ankle joint to see the articulating surface
- Split the superficial fibers of the deltoid ligament, which run anteriorly and distally downward from the medial malleolus, so that wires or screws will be anchored solidly on bone
Dangers
- Preserve the saphenous nerve by preserving the long saphenous vein
- The long saphenous vein is at risk when the anterior skin flaps are mobilized
How to enlarge the approach
Proximal
- Incision can be extended along the subcutaneous surface of the tibia
Distal
- Incision can be extended to expose the deltoid ligaments and the talocalcaneonavicular joint
Figures
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